Patient Communication Study Shows Doctors Regularly Withhold Truth

If you think your doctor is hiding something from you, you might be right.

According to a new study, published Wednesday in the journal Health Affairs, some physicians are not always forthright when it comes to patient communication, withholding information about medical errors, relationships with drug companies and severity of a person's prognosis.

"It should be a source of caution," said Dr. Lisa Lezzioni, a professor of medicine at Harvard Medical School and the study's author. "The caution requires patients to think about and discuss what they want in terms of communication with their doctors."

Researchers surveyed more than 1,800 physicians from around the country, working in a variety of specialties, to ask about how they perceive and handle patient communications.

Nearly 35 percent of respondents said they did not "completely agree" that they should disclose serious medical errors to their patients, and approximately 20 percent said they had not revealed a mistake to a patient in the last year because they feared being sued.

Additionally, 35 percent of the doctors said they did not "completely agree" that they should disclose their financial relationships with drug and medical device companies, and 11 percent admitted that they had told a patient something untrue in the past year.

"Patients and loved ones should expect the truth, absolutely," said Nancy Berlinger, a research scholar at the Hastings Center, a nonprofit bioethics research institute. "Health information is information that is owed to the patient, and if part of that is held back or concealed in some way, then he or she doesn't have accurate information and can't make an informed choice," she added.

Indeed, openness and transparency have been increasingly stressed as core values in medical education and practice in the United States. The study's authors point to the Charter on Medical Professionalism, which has been endorsed by more than 100 medical organizations and which calls for doctors to be honest with their patients to "empower them to make informed decisions about their treatment."

According to the study, the most substantial lapses in transparency seem to occur around patients' futures. Just over half of the doctors surveyed said they had described an individual's prognosis more positively than was warranted within the last year.

"The finding that 55 percent had described a prognosis in a more positive manner than was warranted is pretty significant," Lezzioni said. "They may not want to worry patients, or there may be cultural reasons why it feels inappropriate."

The study notes that lack of training, insecurity over prognostic accuracy and lack of time may also play a role.

But the study did not really delve into why many doctors withhold or color the truth, or what the consequences are. Lezzioni cautioned that the current research is preliminary and that further investigation is needed to "figure out what is going on."

Dr. G. Caleb Alexander, an internist and bioethicist with the University of Chicago, also cautioned that how the questions were posed limits the meaning of the research. Doctors were asked if they "never" or "rarely, sometimes or often" engaged in a particular behavior in the past year.

"There's a big difference between a doctor saying they rarely engage in a behavior and they regularly engage in a behavior," Alexander said.

Overall, the experts seem to agree that the biggest takeaway from the study is that patients and doctors should have a frank dialogue about their expectations when it comes to honesty.

"It's a shared responsibility," Alexander said. "Doctors aren't out there routinely hiding important things from their patients, and it would be foolish to interpret these findings as suggesting that. It is the case that clinical care is complex, nuanced, and that reasonable people may differ in how they should manage situations."